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The CPT® Code 78491 refers to a myocardial imaging procedure utilizing positron emission tomography (PET) specifically designed for perfusion studies. This non-invasive imaging technique assesses the blood flow and perfusion of the heart muscle, providing critical insights into cardiac function. The procedure can be performed either at rest or during stress, which may be induced through exercise or pharmacologic agents. The primary goal of this imaging study is to evaluate the heart's ability to receive blood, which is essential for maintaining its function and overall health.
During the PET myocardial perfusion imaging (PET-MPI), radioactive tracers, also known as nucleotides, are injected into the patient's bloodstream. These tracers emit gamma rays that are detected by a specialized scanner, allowing for the creation of detailed three-dimensional images of blood flow through the heart. This imaging process is particularly important for assessing the left ventricle, which is responsible for pumping oxygenated blood to the body. Key measurements obtained during the study include the ejection fraction, which quantifies the volume of blood ejected from the left ventricle during contraction, and the assessment of ventricular wall motion, both of which are vital indicators of left ventricular function.
The procedure is conducted in a controlled environment equipped with advanced imaging technology. Patients are positioned on a moveable table, and an intravenous (IV) line is established for the administration of the radioactive tracer. Electrocardiogram (EKG) leads are attached to monitor the heart's electrical activity throughout the procedure. A baseline scan is performed before the tracer injection, followed by a series of scans to capture images of the heart from various angles. The uptake of the radioactive tracer varies based on blood flow, allowing for the identification of areas with narrowed coronary vessels, injured tissue, or scar tissue, which will appear as distinct patterns on the images.
In cases where stress testing is indicated, the procedure involves additional steps to elevate the heart rate and blood pressure. This can be achieved through physical exercise on a treadmill or bicycle or by administering pharmacological agents that stimulate the heart. The stress phase is crucial as it provides further information about the heart's performance under increased workload conditions. The combination of rest and stress imaging enhances the diagnostic capabilities of the PET-MPI, enabling healthcare providers to make informed decisions regarding patient care.
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The CPT® Code 78491 is indicated for use in various clinical scenarios where assessment of myocardial perfusion is necessary. The following conditions may warrant the performance of this procedure:
The procedure for CPT® Code 78491 involves several key steps to ensure accurate myocardial imaging. The following outlines the detailed procedural steps:
After the completion of the PET-MPI procedure, patients are typically monitored for a short period to ensure there are no immediate adverse reactions to the radioactive tracer or the stress testing. It is common for patients to experience some fatigue following the stress portion of the test, especially if exercise was involved. The results of the imaging study will be analyzed by a qualified healthcare professional, who will interpret the findings and discuss them with the patient during a follow-up appointment. Patients may be advised to resume normal activities unless otherwise directed, and any specific post-procedure instructions will be provided based on individual circumstances.
| Short Descr | MYOCRD IMG PET 1STD RST/STRS | Medium Descr | MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS | Long Descr | Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic) | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1E - Standard imaging - nuclear medicine | MUE | 1 | CCS Clinical Classification | 210 - Other radioisotope scan |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Changed | Code description changed. |
| 2011-01-01 | Changed | Short description changed. |
| 1998-01-01 | Added | First appearance in code book in 1998. |
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